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The Effects of Health and Housing Quality on Climate Vulnerability and Resilience

Using a case study approach in six frontline communities, Just Solutions has developed a Prioritizing Frontline Communities Framework that assesses the “pre-existing” economic, health, and infrastructure conditions that affect the capacity of these communities to cope with, prepare for, and respond to climate change and to participate equitably in the transition to a clean energy economy. This blog examines the health and infrastructure conditions in these communities that are significant determinants of climate vulnerability and resilience. 

You can read the full report here.

For an in-depth overview on the conditions examined here, join us for our webinar on August 16th, 2023 at 11 AM PST: “The Effects of Health and Housing Quality on Climate Vulnerability and Resilience.” Please register here.

Executive Summary

Through a case study approach, Just Solutions has developed a Prioritizing Frontline Communities Framework for considering and measuring the adaptive capacity and resilience of frontline communities as they confront climate change. It examines the “pre-existing” conditions in six frontline communities that are among the most vulnerable to and affected by climate change and considers the effects of these conditions on the local capacity to cope with, prepare for, and respond to ongoing climate-related challenges. The six communities are Glacier County, Montana; Holmes County, Mississippi; Hidalgo County, Texas; McDowell County, West Virginia; East End, Bridgeport, Connecticut; and East Las Vegas, Nevada. As a counterpoint to these communities, Marin County, California, which lies just north of San Francisco and is one of the wealthiest counties in the country, is highlighted in the data as well.  

In regard to Health and Infrastructure Conditions, we find that: 

  • Poor health outcomes in these communities are not unexpectedly associated with poor economic conditions. Research shows that the social determinants of health, which include economic stability, are the principal drivers of health. 
  • These communities have high rates of chronic health conditions, less access to health insurance and healthcare services, and high levels of household debt, which can frequently involve medical debt. 
  • Economic conditions also put these communities at higher risk of utility shutoffs, which can affect the treatment of chronic conditions, such as diabetes, kidney disease, or chronic obstructive pulmonary disorder (COPD) that are heavily reliant on a stable supply of electricity. 
  • The profiled communities have been hampered by insufficient investment in local infrastructure, including the housing stock and sewage and water systems, for decades. Urban planning efforts that mitigate the effects of climate change, such as tree canopies, have been neglected in these areas. 
  • The environmental clean-up required from past and present industrial activity has not happened. These factors limit communities’ ability to cope with climate change and puts them at significant risk in the event of climate-related disasters.
  • Despite the difficult conditions these communities face, they all have community strengths, demonstrated adaptive capacity and resilience, and an innovative spirit. 
  • There are policies that could be adopted to improve community conditions, increase adaptive capacity and resilience, and ensure a just transition.

For more information on our methodology and a brief history of each community profiled, please view our full report. 

Our study examines three domains: Economic Conditions, Health Conditions, and Infrastructure Conditions in each of these communities. This blog considers the Health and Infrastructure Conditions these communities face and explores policy and community-created solutions. Below, we highlight a few of the less commonly discussed factors that significantly affect the ability of frontline communities to cope with, prepare for, and respond to climate change and climate-related disasters.

Health Conditions

The Health Conditions indicators examined in each of these communities include the following. For this blog, we will focus on the third indicator:

  1. Limited access to health care 
  2. Risk of preterm births 
  3. Higher rates of chronic health conditions

Higher Rates of Chronic Health Conditions

Frontline communities frequently have higher rates of chronic or other health conditions that increase their vulnerability to extreme weather. Poor air quality resulting from extreme heat and wildfires create other hazards, especially for those living with asthma. According to the U.S. Centers for Disease Control and Prevention, those with chronic health conditions such as heart disease, circulatory problems, and obesity are more prone to heat-related illness. Some medications may also exacerbate the effects of heat. The frontline communities we profiled have significant levels of chronic disease. We focused on those chronic conditions that involve electricity-dependent treatments. Some medications, including insulin and other medications used in the treatment of diabetes, must be kept cold. Patients needing kidney dialysis require electricity. Those relying on ventilators and oxygen therapy for the treatment of conditions like COPD and severe asthma also need electricity. Blackouts, shut-offs, and damaged infrastructure from climate disasters put the lives of community members living with these conditions at particular risk.

Infrastructure Conditions

The Infrastructure Conditions indicators we looked at in the report include the following. For this blog, we will focus on the second indicator:

  1. Poor quality of the housing stock 
  2. Outdated or dilapidated water and sewage systems 
  3. Lack of urban planning and climate-mitigation measures 
  4. Increased exposure to industrial hazards  

Outdated or dilapidated water and sewage systems

pumping septic tanks from the backyard tank in the countryside

The local public infrastructure in some of these communities is already in disrepair. In McDowell County, for example, an estimated one-third to one-half of county residents have failing water or sewer systems. Some local residents were under a boil water notice for more than a decade. The McDowell County Public Service District completed its first ever public sewage project in 2022. A previous sewage system was operated by a local mine. When the mine closed, the sewage system deteriorated to the point where it became unusable. Water quality has been an ongoing challenge, with many residents contending with polluted well water. A water quality improvement project was only recently completed. Similarly, West Virginia shared their concern about dilapidated infrastructure: 

“West Virginia has shown that, at the state and municipality level, we’re not prepared to handle climate disasters. Our stormwater infrastructure is based on modeling from decades ago that could not have predicted these higher levels of rainfall. And in terms of heat waves, we have a very high cost of electricity in West Virginia compared to the income of West Virginians. Heat waves increase electricity bills, increasing the cost of living.”

Policy and Community-Created Solutions to Health and Infrastructure Needs

The data above offer a snapshot of health and infrastructure conditions in the profiled communities. Examining the full data contained in the report presents a stark portrait of communities most at risk from climate change. 

At the community level, the “Buen Aire Para Todos” – “Clean Air for All” – campaign is working to improve health conditions in East Las Vegas, Nevada. The project will monitor both indoor and outdoor air quality in the neighborhood. Sensors will be placed in public areas and in local businesses. Mobile sensors will be installed on participating food trucks. “This project will focus on expanding community awareness education and outreach to help residents better understand air quality measurements and the health impacts of poor air quality and extreme heat,” says Jose Rivera of Make the Road Nevada.

In Glacier County, Montana, the Blackfeet Nation has developed a Climate Adaptation Plan in the absence of a state plan. According to Termaine Edmo of the Blackfeet Environmental Office, climate action means “protecting our first teachers or keystone species like Beaver and Bufalo who we look at as leaders and how they care for all beings. Having a Climate Adaptation Plan developed with Piikanii values allowed a new way of merging Traditional Ecological Knowledge with western science. The Plan covers eight natural resource sectors most prominent to the Blackfeet Nation’s people. Each sector has a summary of climate change impacts and goals and strategies identified to combat climate change. We are incorporating as much traditional ecological knowledge as possible for the success of each sector.”

At the state and national levels, the ability of frontline communities to build resilience and recover from climate-related events through improved health and infrastructure all depend on policy change to improve outcomes associated with indicators we have examined. Examples of policy solutions that would bring about meaningful and measurable change include:

  • Stabilizing the grid to prevent blackouts.
  • Strengthening emergency evacuation and rapid response policies and procedures, particularly for those community members with mobility challenges or living with disabilities. 
  • Addressing  the social and environmental determinants of health to improve overall health conditions.
  • Improving access to healthcare, including removing barriers to health insurance for undocumented community members.
  • Expanding Medicaid in the 11 states that have not yet acted. 
  • Funding the early electrification of public transit, delivery vehicles, school buses and other heavy trucks in areas of high air pollution. 
  • Funding home repair and “pre-weatherization” programs to bring homes up to weatherization standards. 
  • Prioritizing frontline communities for stormwater, septic, and water system modernization.


Noelle Angelique M. Molinari, Bei Chen, Nevin Krisha, and Thomas Morri, “Who’s at Risk When the Power Goes Out? The At-home Electricity-Dependent Population in the United States, 2012,” Journal of Public Health Management and Practice, March/April 2017; U.S. Food and Drug Administration, “Information Regarding Insulin Storage and Switching Between Products in an Emergency.”
U.S. News and World Report, “West Virginia Communities Celebrate Return of Clean Water,” April 25, 2022; Washington Post, “After generations of hauling water, a corner of Appalachia still waits for a better future,” June 28, 2021; Bluefield Daily Telegraph, “McDowell PSD working on first-ever sewer project,” July 26, 2021; NBC News, “‘All the water’s bad’: In McDowell County, you have to get creative to find safe drinking water,” June 17, 2021.